Unrestricted utilization of sirolimus-eluting stents compared with conventional bare stent implantation in the "real world": the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry.

Background: The effectiveness of sirolimus-eluting stents in unselected patients treated in the daily practice is currently unknown.

Methods And Results: Sirolimus-eluting stent implantation has been used as the default strategy for all percutaneous procedures in our hospital as part of the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. Consecutive patients with de novo lesions (n=508) treated exclusively with sirolimus-eluting stents (SES group) were compared with 450 patients who received bare stents in the period just before (pre-SES group).

Non-invasive 16-row multislice CT coronary angiography: usefulness of saline chaser.

The aim of this study was to investigate the usefulness of saline chaser in 16-row multislice CT (16-MSCT) coronary angiography. Forty-two patients were divided into two groups for contrast material (CM) administration: group 1 (140 ml at 4 ml/s) and group 2 (100 ml at 4 ml/s followed by 40 ml of saline chaser at 4 ml/s). All patients underwent retrospectively ECG-gated 16-MSCT coronary angiography.

Intravascular ultrasound evaluation after sirolimus eluting stent implantation for de novo and in-stent restenosis lesions.

Aims: The aim of this study is to compare the efficacy of sirolimus-eluting stents (SES) on neointimal growth and vessel remodelling for in-stent restenosis versus de novo coronary artery lesions using serial intravascular ultrasound (IVUS).

Methods And Results: The study population consisted of 86 patients with in-stent restenosis (ISR) (n=41) or de novo lesions (n=45) treated with SES and evaluated by IVUS post-procedure and at follow-up. One 18-mm SES was used for de novo lesions while 16 patients with ISR received >1SES (total stented length 17.

Evaluation of patients after coronary artery bypass surgery: CT angiographic assessment of grafts and coronary arteries.

Purpose: To evaluate the accuracy of electrocardiography (ECG)-gated multi-detector row computed tomography (CT) in enabling the detection of obstruction of both bypass grafts and coronary arteries in symptomatic patients who have undergone coronary artery bypass grafting.

Materials And Methods: ECG-gated contrast material-enhanced multi-detector row CT angiography was performed in 24 patients after bypass surgery. Two independent blinded observers evaluated all graft and coronary segments (> or =2.

Long-term follow-up of incomplete stent apposition in patients who received sirolimus-eluting stent for de novo coronary lesions: an intravascular ultrasound analysis.

Background: Incomplete stent apposition (ISA) has been previously documented after sirolimus-eluting stent (SES) implantation. The aim of this study was to investigate the long-term intravascular ultrasound (IVUS) findings of ISA in patients who received SES.

Methods And Results: A total of 13 patients who received SES and showed ISA at follow-up IVUS (follow-up I) were investigated.

Usefulness of shear stress pattern in predicting neointima distribution in sirolimus-eluting stents in coronary arteries.

The true 3-dimensional neointimal thickness distribution in sirolimus-eluting stents was investigated in relation to the shear stress distribution, which was obtained from computational fluid dynamics calculations. Small pits were observed between the stent struts in all patients, and a significant inverse relation between neointimal thickness and shear stress was found, indicating that deeper pits were present in the outside curve of the stented segments.

MS-CT coronary imaging.

Magnetic resonance imaging and computed tomography (CT) have recently emerged as two techniques that can noninvasively visualize the coronary arteries. The latest generation 16-row detector multislice CT scanner is now considered the most reliable technique to visualize the coronaries. The sensitivity and specificity to detect a significant (>50% diameter stenosis) coronary stenosis is +/-94% and +/-90%, respectively.

Geographical miss during centered intracoronary beta-radiation with 90Yttrium: incidence and implications for recurrence rates after vascular brachytherapy for de novo lesions.

Objectives: The authors sought to determine the incidence and causes of geographical miss (GM) and evaluate its impact on edge restenosis after 'primary', centered, intracoronary beta-radiation therapy.

Background: Edge restenosis is a limitation of intracoronary beta-radiation therapy. GM occurs when the radiation source does not fully cover the injured segment and may account for this phenomenon.

Spiral CT-angiography with one, four, and sixteen slice scanners. Technical note.

Aim of this paper is to describe the technical main features that characterize Spiral Computed Tomography (CT) angiography. In particular, the technical features of the three main generations of single, four, and sixteen multislice scanners have been analised. Particular attention have been addressed to scan and reconstruction parameters, and to the geometry of contrast material related to angiographic scan.

Sensitivity and specificity of QCA in detecting coronary arterial remodeling after intracoronary brachytherapy: a comparison to serial volumetric three-dimensional intravascular ultrasound analysis. Can we detect positive remodeling by luminography?

Background: After treatment with intracoronary brachytherapy, enlargement of lumen (negative late loss) at follow-up has been demonstrated. The aim of the study is to analyze the sensitivity and specificity of quantitative coronary angiography (QCA) parameters to detect a positive vessel remodeling after intracoronary -radiation as compared to intravascular ultrasound (IVUS).

Methods: Twenty-seven patients (27 vessels) treated with balloon angioplasty followed by catheter-based intracoronary -radiation with a (90)Strontium/(90)Yttrium source were assessed by both QCA and three-dimensional IVUS with electrocardiogram-gated pullback.

Intravascular palpography for high-risk vulnerable plaque assessment.

Background: The composition of an atherosclerotic plaque is considered more important than the degree of stenosis. An unstable lesion may rupture and cause an acute thrombotic reaction. Most of these lesions contain a large lipid pool covered by an inflamed thin fibrous cap.

[Non-invasive 16-row spiral multislice computed tomography coronary angiography after one year of experience].

The gold standard for direct diagnostic imaging of coronary arteries is still conventional X-ray coronary angiography, even though for several other applications, noninvasive techniques substituted invasive ones. In the last 10 years several techniques (magnetic resonance, electron beam tomography, spiral computed tomography) attempted to emerge as noninvasive modality for the study of coronary arteries. The introduction of multislice computed tomography (MSCT) with retrospectively gated ECG reconstructions has substantially modified the coronary imaging scenario.

Sirolimus-eluting stent implantation in ST-elevation acute myocardial infarction: a clinical and angiographic study.

Background: Sirolimus-eluting stents (SES) have recently been proven to reduce restenosis and reintervention compared with bare stents. Safety and effectiveness of SES in acute myocardial infarction remain unknown.

Methods And Results: Since April 16, 2002, a policy of routine SES implantation has been instituted in our hospital, with no clinical or anatomic restrictions, as part of the RESEARCH (Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital) registry.

Geographical miss and restenosis during catheter-based intracoronary beta-radiation for de novo lesions.

Objectives: We sought to determine the impact of geographical miss (GM) on restenosis rates after intracoronary beta-radiation therapy for de novo lesions.

Background: GM is the situation in which injured vessel segments (VSs) are receiving low-dose radiation and is accounted for edge restenosis. Its impact on the overall restenosis rates remains to be determined.

Impact of different anatomical patterns of left main coronary stenting on long-term survival.

There are no significant differences in long-term and event-free survival in patients who undergo stent implantation in different anatomic locations of the left main coronary artery. Predictors of long-term survival are age <65 years, normal left ventricular ejection fraction, and absence of an intra-aortic balloon pump.

The black hole: echolucent tissue observed following intracoronary radiation.

Aims: Recent trials in humans have given us insight into some of the consequences of intracoronary radiation. The authors describe a new observation noted on intravascular ultrasound: that of intraluminal echolucent tissue, dubbed the 'black hole', noted at six-month follow-up.

Methods And Results: One hundred and twenty-eight consecutive patients enrolled in brachytherapy protocols were analyzed.

Coronary restenosis after sirolimus-eluting stent implantation: morphological description and mechanistic analysis from a consecutive series of cases.

Background: We describe the clinical and morphological patterns of restenosis after sirolimus-eluting stent (SES) implantation.

Methods And Results: From 121 patients with coronary angiography obtained >30 days after SES implantation, restenosis (diameter stenosis >50%) was identified in 19 patients and 20 lesions (located at the proximal 5-mm segment in 30% or within the stent in 70%). Residual dissection after the procedure or balloon trauma outside the stent was identified in 83% of the proximal edge lesions.

Extension of increased atherosclerotic wall thickness into high shear stress regions is associated with loss of compensatory remodeling.

Background: Atherosclerosis preferentially develops at average low shear stress (SS) locations. SS-related signaling maintains lumen dimensions by inducing outward arterial remodeling. Prolonged plaque accumulation at low SS predilection locations explains an inverse relation between wall thickness (WT) and SS.

Early outcome after sirolimus-eluting stent implantation in patients with acute coronary syndromes: insights from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry.

Objectives: This study evaluated the early outcomes of patients with acute coronary syndromes (ACS) treated with sirolimus-eluting stents (SES).

Background: The safety of SES implantation in patients with a high risk for early thrombotic complications is currently unknown.

Methods: Sirolimus-eluting stents have been utilized as the device of choice for all percutaneous procedures in our institution, as part of the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry.

Noninvasive visualization of atherosclerotic plaque with electron beam and multislice spiral computed tomography.

As an alternative to intracoronary modalities, electron beam computed tomography (EBCT) and multislice spiral computed tomography (MSCT) are able to noninvasively image the coronary arteries. In addition to stenosis detection by imaging the vessel lumen, MSCT has the ability to visualize the coronary artery wall. By using computed tomography (CT), the various components of atherosclerotic plaque may be distinguished and characterized, which holds the promise of, eventually, identifying vulnerable plaque.